Outcomes of home visits for pregnant mothers and their infants: a cluster randomized controlled trial

• Type of Material: Article
• Authors: Ingrid M. le Roux, Philani Maternal, Child Health and Nutrition Project; Mark Tomlinson, Stellenbosch University; Jessica M. Harwood, University of California Los Angeles; Mary J. O'Connor, University of California Los Angeles; Carol Worthman, Emory University; Nokwanele Mbewu, Philani Maternal, Child Health and Nutrition Project; Jacqueline Stewart, Stellenbosch University; Mary Hartley, Stellenbosch University; Dallas Swendeman, University of California Los Angeles; W. Scott Comulada, University of California Los Angeles; Robert E. Weiss, University of California Los Angeles; Mary Jane Rotheram-Borus, University of California Los Angeles
• Language: English
• Date: 2013-06-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Lippincott Williams & Wilkins.; © 2013 Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0b013e3283601b53
• Title of Journal or Parent Work: AIDS
• ISSN: 0269-9370
• Volume: 27
• Issue: 9
• Start Page: 1461
• End Page: 1471
• Grant/Funding Information: This study was funded by NIAAA Grant # 1R01AA017104 and supported by NIH grants MH58107, 5P30AI028697, and UL1TR000124. Mark Tomlinson is supported by the National Research Foundation (South Africa).
• Keywords: maternal health; Virology; Infectious Diseases; PARAPROFESSIONALS; SERVICES; Science & Technology; PROGRAM; ALCOHOL-USE; perinatal health; WOMEN; SOUTH-AFRICA; Immunology; CHILD-DEVELOPMENT; NURSES; HIV; COUNTRIES; COMMUNITY-HEALTH WORKERS; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Objective: To evaluate the effect of home visits by community health workers (CHWs) on maternal and infant well being from pregnancy through the first 6 months of life for women living with HIV (WLH) and all neighborhood mothers. Design and methods: In a cluster randomized controlled trial in Cape Town townships, neighborhoods were randomized within matched pairs to either standard care, comprehensive healthcare at clinics (n = 12 neighborhoods; n = 169 WLH; n = 594 total mothers); or Philani Intervention Program, home visits by CHWs in addition to standard care (PIP; n = 12 neighborhoods; n = 185 WLH; n = 644 total mothers). Participants were assessed during pregnancy (2% refusal) and reassessed at 1 week (92%) and 6 months (88%) postbirth. We analyzed PIP's effect on 28 measures of maternal and infant well being among WLH and among all mothers using random effects regression models. For each group, PIP's overall effectiveness was evaluated using a binomial test for correlated outcomes. Results: Significant overall benefits were found in PIP compared to standard care among WLH and among all participants. Secondarily, compared to standard care, PIP WLH were more likely to complete tasks to prevent vertical transmission, use one feeding method for 6 months, avoid birth-related medical complications, and have infants with healthy height-for-age measurements. Among all mothers, compared to standard care, PIP mothers were more likely to use condoms consistently, breastfeed exclusively for 6 months, and have infants with healthy height-for-age measurements. Conclusion: PIP is a model for countries facing significant reductions in HIV funding whose families face multiple health risks.